The gross non-capital provision in the Estimate amounts to £1,113.828 million. Allowing for appropriations-in-aid at £100 million, the net non-capital grant provisions is £1,013.828 million.
The net non-capital grant provision represents an increase of about £23.9 million on the corresponding out-turn for 1984, which was £989.910 million. This provision includes an amount of £2.5 million for the commissioning of new units. A further £2.5 million is included for services development in the community area, £0.5 million of which has been allocated to the Health Education Bureau. Further provision will be required to meet the cost of implementation of approved pay awards.
The capital provision included in the Estimate amounts to £57 million.
The level of non-capital expenditure in 1985 which can be approved on the basis of the subhead provisions in the Estimate is about £1,195 million in gross terms, or £1,122 million taking account of income which is received directly by the health agencies such as payments for maintenance in private and semi-private accommodation in public hospitals. The gross estimated expenditure of £1,195 million represents an increase of £66 million on the corresponding figure for 1984. It comprises £740 million in respect of pay, £393 million in respect of non-pay, excluding cash allowances, and £62 million in respect of cash allowances. About 86 per cent of the gross expenditure will be met from Exchequer funds.
The approximate breakdown of estimated gross expenditure of £1,195 million in 1985 between programmes is as follows:
|
£M or % |
||
|
Community Protection |
19.4 |
1.6 |
|
Community Health Services |
154.9 |
13.0 |
|
Community Welfare |
93.7 |
7.8 |
|
Psychiatric Programme |
139.8 |
11.7 |
|
Programme for the Handicapped |
117.7 |
9.8 |
|
General Hospitals |
610.3 |
51.1 |
|
General Support, including |
||
|
research |
59.4 |
5.0 |
The percentage of overall expenditure in general hospitals is noteworthy in relation to the possibility of gradually shifting expenditure from a hospital to a community setting, as envisaged in the national plan. Indeed, if all institutional costs were combined, they would amount to about £838 million of the gross 1985 Estimate and represent up to 70 per cent of total expenditure. It is thus not unrealistic to envisage the possibility of a shift of some expenditure from institutions to the community.
I am aware, as most Deputies are, that there are institutional services provided in the country which are neither essential to the system of health care delivery nor indeed to the state of health of the community.
No major speech in relation to the health services can omit a reference to the considerable growth in expenditure that has occurred on the services, particularly in the last decade. In 1973-1974 net expenditure amounted to about £143 million, representing about 5.2 per cent of GNP. In the current year it will be of the order of £1,122 million, representing about 7.2 per cent of GNP. While this percentage is high, it has in fact declined from a peak of around 7.9 per cent in 1982.
The factors responsible for the increase in expenditure over the years are pay and price inflation, extension of eligibility for certain services, and improvements and developments of services. In recent times the range and depth of our services have grown rapidly, embracing many new technological advances as well as considerable expansion in the area of personal social services. Not unexpectedly these improvements gave rise to significant extra costs.
Health agencies, including health boards, public voluntary and joint board hospitals and homes for mentally handicapped persons were notified in December 1984 of the approved non-capital allocation levels for 1985. Prior to that — on 16 November 1984 — I met with the chairmen and chief executive officers of health boards and dealt in some detail with the difficulties and opportunities in the health services over the next few years and the necessity to develop plans in accordance with the thrust of the national plan. I alerted the health boards to the need to produce action plans for 1985 spelling out in detail the measures proposed to contain expenditure in 1985, in particular, within approved allocation levels.
Deputies will be aware of the furore in certain quarters about the levels of allocation approved for 1985 and unnecessary and alarming references to the alleged suffering and even deaths which are likely to arise because of measures needed to achieve budgetary targets. I have accepted that the financial situation is difficult. It will call for the exercise of skilful and unrelenting management of resources throughout the year. I am firmly convinced, however, that the funds available are sufficient to enable vital services to be maintained at a satisfactory level and I am also convinced that efficient management of that resource would ensure that the community would be guaranteed the health services essential to its wellbeing. I regret the extreme and irresponsible comments on the situation which are not helpful. They are related to political exigencies rather than to realities.
I am glad to be able to say that I have obtained a capital allocation of £58 million — of which £57 million will come from the Exchequer and £1 million from other sources — for the coming year. This will allow me to keep major programmes of improvement of facilities on stream and to make progress in the planning or building of all projects which I consider essential to preserving the fabric of the health services.
In the general hospital services area, the major schemes at St. James's, the Mater, Cavan and Mullingar will continue. Tenders have been invited for the development of Castlebar General Hospital. In the case of Ardkeen Hospital, I have approved urgent improvement works to go ahead in advance of the overall development of the hospital. Planning of proposed developments at Tallaght, Kilkenny, Wexford, Sligo and Naas will continue. The Midland Health Board have devised an excellent rationalisation programme for general hospitals in their area, including a regional orthopaedic service at Tullamore, and I will be supplying the necessary capital resources for the implementation of the programme. In addition, smaller improvement works — for example, improvement of out-patient and day hospital facilities — will be undertaken at other hospitals.
In the psychiatric service it is intended to continue improving standards in the major psychiatric hospitals, to build or plan a number of new day hospitals and day care centres and to commence development of small psychogeriatric units to improve standards at St. Brendan's Hospital, Dublin. On the mental handicap side, the commissioning of the new centre at Cheeverstown House, Templeogue, commenced last year and when completed this centre will provide 130 residential places and 154 day care places.
Other developments in the mental handicap services include the allocation of £700,000 towards the end of 1984 for innovative recreational and community-based facilities and for minor improvement schemes. In the current year I intend to introduce a planned programme of maintenance works in centres for mentally handicapped people. I am also making special provision to develop a small number of residential facilities for the physically handicapped in line with the recent Green Paper on services for the disabled. In this connection also developments will occur at St. Laurence's Cheshire Home, Cork, and the Barrett Cheshire Home in Dublin. I have just approved the acceptance of tenders for new residential accommodation at St. Joseph's School for the Deaf in Cabra. Construction on this project should start almost immediately. Another major development will shortly commence at St. Mary's School for the Deaf, and planning will proceed for developments at St. Mary's School for the Blind.
Building or planning for essential developments to cater for the needs of the elderly will also continue. Construction of the new geriatric unit at St. Oliver Plunkett hospital will proceed. The building of the new 100 bed replacement geriatric unit at the Sacred Heart Home, Carlow, has just started and planning for other major projects at Dungarvan and elsewhere will continue.
I will also be providing funds to build or plan a number of new health centres and clinics, and to improve existing community care premises. Tenders have been accepted for Blessington health centre. In the case of the proposed health centre for Athlone planning is at an advanced stage and it is hoped that the scheme will go to tender before the end of the year. In addition, community-based treatment and rehabilitation facilities for drug abusers will be developed and the youth development centre at Dundrum is now virtually complete.
All these projects represent the commitment of additional investment in the health services in building up a modern infrastructure suited to today's needs.
As a broad guide to the ways in which resources are applied I would refer Deputies to the 1984 edition of Statistical Information Relevant to the Health Services which I circulated some time ago. This volume contains a wide variety of useful information in the fields of vital and health statistics. It gives a very good view of the range of activity in the health service and the framework within which the services function. It also contains a section on vital statistics and the trends in this area have, of course, a significant bearing on demand for health services. The sections of the population aged under 15 years and over 65 make particularly heavy demands on the health services. The high proportion of our population in these dependent age groups relative to other developed countries is a noteworthy feature of Irish demography. The number of elderly people is of particular relevance since much increased utilisation of health services is a feature of advancing years. While people aged 65 and over represent about 11 per cent of the population, they occupy on average about 40 per cent of the beds in our acute hospitals.
Other points of interest in our demographic trends are the increase in life expectancy, the continuing decline in infant mortality and the decline in births in recent years. The decline both in the number of births and the birth rate is quite marked. For example, the annual number of births declined by more than 7,000 between 1980 and 1983. Looking at that figure, and bearing in mind the demand for extra staff, one wonders what the talk is all about. However, the point is relevant and one which is difficult to get across to people. The collation and publication of these statistics and identifying the trends they imply are an important element in the planning of future health policies.
The strategy for health services over the next three years has been set out in the national plan —Building on Reality. The future objectives of health policy have been shaped by a continuing increase in demand at a time of general financial restriction. The main elements in the development of policy will be a shift towards prevention of disease and an emphasis on community care, ensuring that scarce resources are directed more specifically at those in greatest need.
While there will be a modest decline in real terms in the resources available for health services over the period of the plan, the very fact of knowing the parameters within which we must work over the three years facilitates a planned and orderly approach to the allocation of resources. I am confident that we will not only be able to preserve the essential fabric of our existing services but to re-deploy resources as necessary to develop other essential services in the health area. At the same time we have set ourselves the challenge of delivering in each of the years 1985 to 1987 a more cost-effective service to the public. At the end of the day this theme of "value for money" must be the goal at a time of financial scarcity and in this respect I think I would have the agreement of the providers of services as well as the general health economists and other commentators.
I am conscious of the dependent relationship between the commitment of health staffs and achievement of the objectives set for the health services. The strength, efficiency and effectiveness of the health service is largely dependent on the skills, training, motivation and overall competence of its personnel. In the public mind the perception of the health services is of doctors and nurses attending to the needs of the sick and the dying. However, they are, of course, supported by a whole range of staff, services and equipment — for example, in the areas of catering, housekeeping, maintenance and administration. One is talking about close on 60,000 persons in the service.
In the current economic climate the health service is being asked to increase staff productivity by maintaining the overall quality of services while reducing the number of man hours worked, broadly in line with the level of reductions sought in the Civil Service. This, of course, is not an easy task. But since restrictions on staffing were first introduced in 1981 — they were introduced by the Opposition although there is not a peep out of them now when it comes to the implementation of the policy, but that is another fact of life we are facing— the health service has generally managed, with some exceptions in 1984, to live within its pay allocation.
Much, however, still remains to be done to ensure that expenditure on staff resources is tightly controlled and that the resources are used in the most effective manner. The bulk of health employees work in hospitals which are organisations of considerable complexity. The hospital and other institutional settings provide the greatest opportunity for planned changes in personnel productivity because of the large concentration of personnel within individual physical facilities, the interaction between the many different categories of staff in the delivery of a total service and the pace and extent of technological development, particularly in the acute hospital area.
Very little research or study has been conducted here in identifying areas for decreasing costs and improving the performance of hospital manpower. Between 1978-79 the Department of Health, under the direction of the Minister of the day, inquired from health boards why they were not employing more staff and demanding that they take some more on. Health boards replied that they did not need them, but they were directed to take them on and ensure that returns were sent to the Department so that the new employees, whether needed or not, could be informed of how wonderful it was that they could be given jobs. The taxpayer is paying for that ever since.
The pursuit of this objective of identifying areas for decreasing costs and improving the performance of hospital manpower must become a matter of major priority in the coming year and in the years ahead. It is a task to which each agency must address itself and in which all the necessary support and assistance from my Department will be made available.
The way in which health personnel perceive their responsibilities is critical to the control of expenditure and the achievement of value for money. The employing agency controls the amount of resources made available; the resource user determines, to a large extent, the value obtained for the expenditure. It is this reality which makes management in the health services particularly difficult; but there are proven means of coping, provided there is the willingness and ability to invest heavily in information systems and in the development of people as managers.
I would now like to refer briefly to what is being done in these areas by the Department. In the health services, we have embarked on a major programme to improve various facets of information. We are doing this during a period in which resources will continue to be scarce and existing resources must be creatively managed in order to maintain the required quality and quantity of those services deemed to be most essential. We must give far greater attention than heretofore to what outcomes the service produces as well as looking at all aspects of cost. In many respects the challenge to the health services in the next few years is to move smoothly from administration to management of resources.
The first objective of the programme for the improvement of systems is to provide a better service for patients and clients. It is hoped that good systems will lead to safer, quicker communication between professionals and will also lead to quicker throughput of patients, particularly in large general hospitals. The provision of additional more rapid information on patients and clients will help to frame more effective policies and procedures on admissions to hospitals and institutions.
The second objective is to support the development and implementation of accountable devolved management throughout the system. The ultimate aim is to enable resource users to become budget holders and provide them with accurate timely information not only on what has happened but what is happening. We must provide an early warning system at various levels of management so that corrective action can be taken quickly when budget targets are not being met or agreed outputs are not being achieved.
The third objective is to improve the quantity and quality of information available for policy formulation and review, for planning and resource allocation. Better information on what is being achieved in the service and at what cost will provide an improved basis of resource allocation at national level. It will also help to provide more reliable comparisons between different parts of the service and it will provide a scope for increased use of modelling, helping managements to predict the likely outcomes of various policy alternatives.
Finally, the improvement in information systems, properly adapted, will provide a better basis for research. The availability of more and better information on both outputs and inputs should aid both services research and epidemiology, both of which are crucial to the maintenance of good standards and the taking of correct policy decisions. I was amazed at the lack of detailed effective information when I took office. A lot of the inadequacies were identified and action taken. I have no doubt that we will have greater aspects of critical information available to us in 1985 and the years ahead.
Eligibility for medical cards is normally determined by the chief executive officer of the appropriate health board by reference to agreed income guidelines. I was pleased to be able to announce the revision of these guidelines with effect from 1 January 1985. The new guidelines compensate fully for changes in the cost of living during 1984.
Included in these guidelines is an age allowance for persons aged 66 years and over. This age allowance was introduced from 1 July 1984 and amounts to £5 per week for a single person aged between 66 and 80 years and £8 per week for a person aged 80 years or over. The allowance is doubled if the individual is married. The introduction of this allowance marked a significant improvement in the position of people aged 66 and over.
In accordance with the guidelines a married man aged 66 years or over can have income of up to £100.50 per week — £106.50 if over 80 years — and be entitled to a medical card. This limit will be higher if he has outgoings in excess of £10 per week in respect of his house. At 31 March last, 37.2 per cent of the population were covered by medical cards as compared with 36.75 per cent on 31 December 1984.
The income ceiling for hospital service cards which entitles the holder to free hospital consultant services was increased to £13,500 with effect from 1 June 1985. This revised figure applies to income earned in the year ending 5 April 1985.
Responsibility for collection of current contributions from farmers was transferred from the health boards to the Revenue Commissioners on 6 April 1984. The collection of arrears outstanding on that date remains the responsibility of the health boards. In the 12 month period ending on 31 December 1984, a total of £2.3 million was collected by the health boards as farmers' health contributions. The boards will continue their efforts to recover these arrears, taking legal proceedings if necessary, in a selected number of cases. As an incentive to the boards I have arranged, with the agreement of the Minister for Finance, that the boards will be given the benefit of arrears of health contributions which they collect from farmers in the course of the year commencing on 1 January 1985.
Because of the limited time available, I will shorten my speech. In my circulated script I have said how these contributions will be credited to the Exchequer and then I said that the regulations to give effect to the proposal to apply an admission charge of £100 to any person presenting for hospital treatment who is in arrears with health contributions came into operation on 1 June 1984 and I went on to clarify that aspect. Regarding legislation, my Department have in hands the preparation of a range of legislation designed to improve a variety of aspects of the health and welfare services.
As regards the Children Bills, one of my primary objectives as Minister for Health is to reform the law in relation to the care and protection of children. Our present provisions in relation to children are based largely on legislation dating from 1908. Much of it is now outdated and is not sufficiently in keeping with current concepts in regard to child care. In the next part of my speech I deal with the first of the three Bills now before the House and set out the new arrangements.
On the question of adoption, my Department are in the process of preparing the scheme of a Bill to amend the Adoption Acts, in the light of the recommendations of the Review Committee on Adoption Services. I hope to be in a position to circulate this Bill towards the end of this year.
The Minister for Justice, for his part, has circulated for discussion the draft text of a Status of Children Bill. This aims to eliminate as far as possible the differences that now exist between the way in which the law treats children born inside marriage and those born outside marriage.
The Government are also committed to bringing forward revised measures in regard to juvenile justice. This will be the subject of a further Bill. I am confident that these Bills taken together will give us a solid body of enlightened and up-to-date legislation in relation to children.
Under the new Dentists Act, 1985, I expect the new Dental Council to be set up and hold their inaugural meeting early in November next.
Members of the House will be familiar with both the purpose and the detail of the Nurses Bill. This major legislation will update and replace existing legislation to restructure An Bord Altranais, to improve the arrangements for the regulation of the profession and to give statutory effect to the EC directives. The Bill was passed by the Dáil on 22 May, and hopefully will complete its passage through the Seanad in the early autumn. I am glad the Seanad will be taking the Second Stage of this Bill later this month.
The enactment of this Bill will provide a very good statutory framework for the future development of the profession and the further enhancement of its contribution to the health services. I would like to take this opportunity to pay a special tribute to the work which has been undertaken by the current board and by its chief executive in not only dealing with the problems of today but in doing much of the groundwork necessary to quickly implement the provisions of the new Bill.
Today I circulated the Health (Amendment) Act, 1985, to amend the Health Acts, 1947 to 1970, to enable health boards to charge for services provided for victims of road traffic accidents. Charges had been made for these services under Article 6 of the Health Services Regulations, 1971, but the Supreme Court has ruled that the provisions of this sub-article were ultra-vires the powers conferred on the Minister for Health. I have rectified the position in the Bill circulated today. The loss in revenue to health boards and hospitals resulting from this decision is estimated at £4 million to £5 million in a year.
I now come to the registration of hospitals and homes. For a considerable time it has been my view that there is a glaring omission in our legislation in that there was no control or statutory regulation governing the establishment of most types of hospitals and nursing homes outside of those administered by health boards or corporate bodies. Such statutory regulation, I believe, is essential and long overdue. I have drawn up detailed proposals for appropriate legislation in this area. A considerable amount of work has already been done and I would hope to have my proposals completed in the very near future.
For some time past it has been evident that there is need to up-date certain provisions in the Voluntary Health Insurance Act, 1957, to take account of significant changes which have occurred since the Voluntary Health Insurance Board was originally set up. These changes include the remarkable growth in membership of the Voluntary Health Insurance Board's schemes which now exceeds 366,000 and covers a total of over 1,000,000 persons. Other factors are the considerable expansion of health service facilities over the last two decades and in more recent times proposals by entrepreneurial interests to establish a number of private hospitals in which treatment costs are likely to far exceed treatment costs in the existing range of hospital facilities. I hope to introduce the necessary amendments to the VHI Act during the course of the current year.
Members of the House will be aware of the decision of the Supreme Court regarding maternity services at Monaghan Hospital. I have considered carefully the implications of that decision and have come to the conclusion that an amendment to the Health Act, 1970, is necessary. Otherwise we would be faced with an absurd situation in which it might be impossible to discontinue any hospital service no longer required. I have recently submitted proposals to Government in this regard.
Regarding family planning, Members of the House will be aware of the significant improvement in access to family planning services marked by the recent passage of the Health (Family Planning) (Amendment) Act, 1985, by the Oireachtas.
The effect of the Act will be to spare people of mature years and, indeed, in many cases young years the inconvenience and unnecessary expense involved under existing legislation in obtaining a medical prescription for condoms. It will also extend the outlets from which non-medical contraceptives may be purchased to include doctor's surgeries, health centres, licensed family planning clinics and voluntary hospitals providing maternity services or services for the treatment of sexually transmitted diseases.
As regards the setting of the age limit at 18, all parties in the Oireachtas had already decided last year, with hardly a dissenting voice, that the age of majority should be reduced to 18 years and this change has been duly effected by the Age of Majority Act, 1984. This Act essentially confers full adult status upon each citizen at 18 years of age with regard to rights, duties and responsibilities in general. It would have been quite ludicrous to have ignored this recent Age of Majority Act in the context of setting the age limit in the amended family planning legislation.
I am currently examining the measures which need to be taken to give effect to the objectives of the new legislation, including an up-to-date survey of the present availability of services around the country. On completion of this examination, I will bring the 1985 Act into effect. I anticipate that I will be in a position to do so shortly.
I now come to the care programmes. Quite apart from the introduction of new legislation, my Department are continuing their efforts in the development of health policies and in making the services more responsive to real needs.
Regarding community protection, as indicated in the national plan, a major growth in emphasis can be expected in the future in the whole area of preventive health care. While we now live longer and enjoy better health than any previous generation, we still suffer from much preventable death and illness by the standards of comparable countries.
There is widespread agreement that lives could be saved and active life prolonged by an effective programme of health promotion throughout our community. Health promotion is both the responsibility of the individual and of society at large.
The Health Education Bureau have had considerable success in getting the message across to people that health is a limited resource which can be husbanded and protected by pursuing a lifestyle which gives health every chance. They have placed particular emphasis on encouraging young people not to smoke and to drink in moderation. I made an additional £500,000 available to the bureau to develop their promotional activities in this field and there is evidence of that in our community.
As Minister for Health, I have a responsibility to encourage a more responsible attitude to smoking in society. My aim is to encourage an environment in which the pressure to smoke is reduced and in which the entitlement of non-smokers to a smoke-free environment is respected. To this end, I have the agreement of Government to strengthen existing controls on tobacco advertising and to introduce new legislation to restrict smoking in certain public places and to impose a levy on the advertising budgets of tobacco companies, the proceeds of which will assist the Health Education Bureau to extend their activities in counteracting the harmful effects of smoking. A range of other initiatives is also being taken in the preventive area.
Regarding infectious diseases, I will be launching a measles vaccination programme in the autumn as part of my Department's recommended programme of immunisation and vaccination. Contrary to the popular perception, measles can be a serious illness. It gives rise to expenditure in the health services which is avoidable if an effective immunisation programme, which can be established at considerably less cost, is in operation. The necessary arrangements to ensure the success of this programme are now well under way, including the arrangements to involve general practitioners for the first time officially in the Department's recommended programme.
In the area of sexually transmitted diseases, a review of my Department's control measures is now under way. The 1981 Infectious Diseases Regulations are being revised to make provision for the notification of certain non-specific diseases which are becoming more common in the community. The Department's circular on sexually transmitted diseases is also being revised and up-dated to ensure that an adequate STD service is being provided in all health board areas.
Regarding the acquired immune deficiency syndrome, known as AIDS, this is a relatively new illness which was not recognised as a disease entity until 1984. In July 1984 my Department established a detailed monitoring system identical with that used by the World Health Organisation and the EC. The primary objective of this system is to facilitate the regular dissemination of up-to-date information regarding AIDS and to ensure prompt reporting and surveillance of cases of the syndrome in this country. Six cases of this disease have been seen in Ireland since 1981.
Some concern has been voiced at the danger that this disease might be spread through blood products. The Blood Transfusion Service Board have taken steps to minimise any risk to Irish patients in this regard. All necessary measures are being taken to guarantee the purity of the products supplied by the board.
Regarding drug abuse significant progress has been made in this area since the Misuse of Drugs Act, 1984 was brought into operation.
In the area of education, a set of five video films was developed by the Department of Education, in co-operation with the Health Education Bureau, for use within the context of "Life Skills" type programmes in second level schools, youth club settings, or with parent groups. The HEB also produced, in conjunction with the City of Dublin VEC, a new booklet entitled Understanding Drugs. This is being made available on a limited basis during the current year. Also a lecture series has been organised to accompany the release of the booklet. In addition, I made funds available to Trinity College to enable them to provide a diploma course in addiction studies.
In the area of research, the Medico-Social Research Board were asked to carry out a number of surveys on specific aspects of the drug problem among adolescents. These surveys were completed towards the end of 1984.
The Government Task Force on Drug Abuse recognised that the treatment and rehabilitation facilities currently available for drug abusers were inadequate. In response to this, my Department expedited the planning of an appropriate unit and a suitable location for this has recently been identified and negotiations are now in progress for its possible acquisition.
Additional funds were made available to the Coolmine Therapeutic Community to help them meet the increasing demands being made upon their services. The Coolmine Community also submitted proposals for the expansion of their existing induction centre in the inner-city area of Dublin and the establishment of an induction centre in Dún Laoghaire. I was pleased to be able to make funds available to enable them to proceed with these proposals and, in fact, I recently opened the new centre in Mulgrave Street in Dún Laoghaire.
In addition to the foregoing, the task force also recommended that a new national co-ordinating committee should be established to replace the existing inter departmental committee which was set up on an informal basis without specific terms of reference. I established this new committee earlier this year. This committee now have the responsibility for monitoring progress made in implementing all of the recommendations of the task force and they will be obliged to submit a report to the Minister for Health annually.
Two meetings of Health Ministers of the EC were convened during the Irish and Italian Presidencies in 1984 and 1985 to discuss health questions, including that of drug abuse. A very wide and fruitful exchange of views took place on the drug problem and it was agreed that the EC had an important role to play in this area. The Commission are actively pursuing this at the moment.
Regarding clinical trials, I have completed consultations on an outline of my proposals for the legislative control of clinical drug trials and I have obtained Government approval to the preparation and introduction of a Bill for this purpose.
Regarding the licensing of non-proprietary medicines, in October 1984 I introduced the Medical Preparations (Licensing, Advertisement and Sale) Regulations, 1984. The purpose of these regulations is to control the marketing of medicines for human use. The control is effected by means of a common licensing scheme which applies to all human medicines, both proprietary and non-proprietary, namely generic. The regulations replaced the European Communities (Proprietary Medicinal Products) Regulations, 1975, which related only to proprietary medicines.
Regarding milk and meat, a number of Deputies have raised this issue on a number of occasions in the House. Health boards are continuing their food sampling programmes at retail outlets and pay particular attention to meat and milk. The system of severe financial penalties introduced by my colleague, the Minister for Agriculture, which applies to producers of liquid milk who supply milk contaminated with antibiotics has proved to be a very effective control measure.
The condition of slaughterhouses supplying meat for the home market has been a continuing cause of concern to both the Minister for Agriculture and myself over the years. The Government have now decided that the standards of meat inspection and hygiene at these slaughterhouses must be brought up to the standard which already applies at our meat export factories.
My Department are in close touch with the Department of Energy concerning the discharging of radioactive waste from the nuclear processing plant at Sellafield. Following on the report of the Independent Advisory Group set up in the UK under the chairmanship of Sir Douglas Black on the investigations carried out into the possible increased incidence of cancer in West Cumbria, my Department set up an epidemiological study into the incidence of childhood leukaemia in this country. This study is well advanced. It is only when this study is completed that it will be possible to establish whether or not there is an increase in these cases on the eastern seaboard. This study will also examine the available evidence relating to the hypothesis that there is an excess of Down's Syndrome on the eastern seaboard.
There is a growing awareness of the environment and a developing awareness of the influence which the environment can have on the health of our people. I am anxious to foster this awareness of what we call "environmental health". Incidentally, the air conditioning system in Leinster House could do with a little "environmental health" from time to time.
A good deal has been spoken and written about the environment in recent years. However, sometimes there can be a tendency in the debate and among the various bodies dealing with environmental issues not to give due attention to the environmental health aspects. I think it is not always appreciated that a concern for environmental health is intrinsic to, and cannot be separated from, a concern for the environment generally. It can be readily seen there are implications for environmental health in the activities of a wide range of Government Departments and agencies and I am anxious that there should be a general understanding between them of their responsibilities in this regard.
The inner city of Dublin is in dire condition and any Minister for Health who survives a number of years in the Custom House which is in the centre of the city deserves a medal and the staff who work there deserve certificates. I hope that in the immediate future the Minister for the Environment and I will endeavour to make some improvements with regard to air pollution in the centre of Dublin. The situation is extremely bad and there is urgent need for stringent action.
Regarding the report of the working party on the GMS, I have outlined data well known to Deputies here. Negotiations between my Department and the IMO arising from the report commenced last December. These discussions are at an advanced stage and I hope they will result in significant improvement in the operation of the GMS scheme.
The cost of pharmaceuticals such as drugs and medicines is a major and readily identifiable component of overall costs in the operation of our health services. We are spending £115 million per year in this area. My Department are examining several aspects of the matter, including the degree to which further economies and savings are achievable.
The overall position of the public health services in this regard has improved significantly under the terms of the present agreement between the Department of Health and the Federation of Irish Chemical Industries. The present agreement has effectively controlled the prices of drugs used by the GMS scheme and by the various publicly funded health institutions. The savings to the taxpayer effected by the terms of this agreement are estimated at about £12 million for 1984. That is not to say I will not be taking a rigorous look at the agreement which expires at the end of September. Negotiations have commenced already with a view to drawing up terms for a new agreement to take effect from 1 October next.
The general review of public dental services which commenced in 1982 is continuing. The parties to the review are the Departments of Health and Social Welfare and the Irish Dental Association. Although the present financial situation will not permit the implementation of any modification to the existing services which would involve additional funding, the review is being continued on the basis that it will provide a blueprint for possible future developments when financial circumstances permit. A national survey of the dental health of children was undertaken in March-June of 1984. Approximately 7,500 children were examined. It was an extremely valuable survey and, at a cost of £120,000 which was financed by the Department of Health, it was money well spent. I was very pleased at the exceptional competence of that report.
In the context of the commitment to community services in the national plan, the provision of an effective home nursing service, especially in regard to the aged, is a priority. To be fully effective, a home nursing service needs to be complemented by an expanded home help and meals-on-wheels service. The plan recognised that the integration of medical and social services holds the potential to ensure a comprehensive and planned response to the needs of vulnerable groups. I will do everything possible to expand that service.
The last major review of services for the elderly was the 1968 report. We are now embarking on a further major review and I hope to have that report published within 18 months. The Department have been exceptionally busy with their work. The reappointed National Council for the Aged have published valuable research papers on matters affecting the aged and they, with the Department, have done a great deal of work in that area.
The Government in the document Building on Reality announced that special attention would be given to the needs of travelling people. My Department have a particular responsibility in this area. A monitoring committee was established in September last to review progress towards the Government's objectives. I am pleased to say there has been satisfactory progress in the key areas of health, accommodation, labour and education. There have been monthly meetings and reviews and action has been taken on the matter. My Department have issued comprehensive guidelines on a number of essential health services for travellers. The important additional point I would bring to the attention of Members is that following discussions between the Eastern Health Board and the Department a pilot mobile health clinic for travellers in the Dublin area was scheduled to operate from early July. It is in operation this week. If any Deputy wishes to see the clinic he is welcome to make the arrangement. The clinic will provide developmental services, anteand post-natal care, immunisation and health education for travellers. It represents potentially one of the most significant advances in the provision of health services for the travelling community. I expect to visit it next week. This has been particularly useful.
Regarding the homeless, I am glad to say that the report of the ad hoc committee was completed in December, 1984. The report sets out the guidelines to be followed by statutory agencies with responsibility for the care and accommodation of homeless people. I hope the local authorities and the health boards will be able to respond quickly and decisively to the problem of the homeless.
The work of the National Social Services Board has continued apace. It is doing excellent work and I want to commend that board which was appointed last July for the exceptional work they have been doing for the last 12 months.
I now come to the psychiatric services programme. I have received the report of the study group which was established in this area. I have circulated the report to the various parties concerned and I will be pressing for early implementation of the report's recommendations.
The study group report envisages a gradual transition from a service provided mainly in the larger psychiatric hospitals to one which is largely community-based and where in-patient treatment is only one component in a network of services. The steps needed to bring about this major change are described in the report and quantitative norms are set out for the provision of the various services. In particular, these services include day services and workshops, out-patient clinics, hostels and other forms of residential accommodation.
I will be pressing forward with work in this area. For example, out-patient clinics are now well established in all of the health board areas. Day care services are also on the increase, while there are now some 1,000 places in hostels for the mentally ill. I am confident that there is potential for placing many more patients in this form of community-based accommodation and this will be given special attention in future. Equally, I made a substantial sum of money available in the last three years to carry out improvements in the living conditions of patients in these hospitals. I have been around to a number of the hospitals. The improvements are visible. They are certainly well overdue and they were badly needed but the work is being done and I would invite Deputies who want to see particular aspects of the work to visit the hospitals concerned.
The Green Paper on Services for Disabled People was published in April of last year. One of the aims of the Green Paper was to stimulate a debate among disabled people and the various groups specifically interested in this area. I have now received a number of detailed submissions on the paper. I shall be arranging for officers of my Department to meet with the organisations and I intend to hold a conference in the near future to discuss certain key areas in the Green Paper.
Regarding the physically disabled, as assured in the Green Paper, I am making provision in the capital programme for the introduction of a number of improvements in the residential care area for the physically disabled. I recently announced that I was making funds totalling almost £10 million available for the developments in St. Mary's Home for the Blind, Merrion. These improvements will include new accommodation for the adult blind to replace the existing out-dated facilities, as well as a new children's residence. Planning of both of these projects are proceeding and I expect building of the children's unit to commence this year.
I was also pleased to make capítal funds available for the Barrett Cheshire Home, Dublin and the St. Laurence's Cheshire Home, Cork. I am providing a grant of £200,000 this year to the Barrett Cheshire Home for an eleven-room ground floor extension. I am also making £500,000 available to the St. Laurence's Cheshire Home over a two-year period for the provision of 28 single-bed units to replace existing unsatisfactory accommodation. I have made £80,000 available for the running costs of a new short term hostel for ten to 12 people which is planned for the Cork area. I was down there recently. The hostel will be run by three voluntary organisations for the physically handicapped operating under the group name "ABODE"— Association for the Benefit of the Disabled in the Environment.
Finally in this area I recently announced that I had accepted tenders for the provision of residential accommodation and ancillary facilities for 96 boys at St. Joseph's School for the Deaf, Cabra. The Minister for Education has approved tenders for educational accommodation at the school. Both elements of the project will go ahead in tandem. The total cost of the development will be about £5.2 million of which my Department will be providing about £3.7 million.
Regarding the mentally handicapped services — and here I hope that those who were so busy circulating the parents of the mentally handicapped before the local elections will bear with me when I make the point that I am conscious that much remains to be done before our total needs in the mentally handicapped area are met — I strongly hold the view that in the past two years if I have done anything in the Department of Health I have made very substantial additional resources available in this area. I made additional funds available to supplement resources at the end of 1984 in order to assist them to meet the cost of those projects.
The findings of the census of the mentally handicapped, which was recently published, give rise to questions on the planning norms contained in the 1980 Working Party Report on Services for Mentally Handicapped People. These may need to be reviewed. I have asked senior officials of my Department to report to me on the planning implications raised by the census findings. I can assure Deputies that that area has been a particular priority. In the past year I visited a number of centres and the outstanding work being done in those centres continues to impress all of us enormously.
I now come to the general hospitals programme. In the area of general hospital services the process of rationalisation and development initiated some ten years ago continues to progress. It is ironic that when a Labour Party Minister for Health holds office progress tends to accelerate and they get very little thanks for doing it but the work must be done in the national interest and certainly the work I have managed to do in the last two and half years in this area will I think be accepted in the years ahead as quite exceptional.
In regard to the rationalisation of services, perhaps the most radical changes will take place in the greater Dublin area. The future hospital system in Dublin will be centred on six sites namely, Beaumont, the Mater, St. James's, St. Vincent's, Blanchardstown and Tallaght. These projects are all at various stages of planning and construction. I have been disappointed with some of the attitudes I have encountered particularly in the transfer of Jervis Street and St. Laurences Hospitals to the new Beaumont Hospital. Because of the impasse which has been reached in negotiations with the consultant medical staff of the two hospitals, I have now informed the boards of the two hospitals, Beaumont Hospital Board and the Royal College of Surgeons, that I no longer consider it feasible to transfer the services of Jervis Street and St. Laurence's Hospitals jointly to the new hospital in Beaumont. I have decided consequently that, on a date to be agreed, St. Laurence's Hospital will cease to be funded as a general hospital and all of its services will from then be provided in Beaumont Hospital. I have also decided that the services in Jervis Street Hospital will remain in their present location to the extent and in the form to be agreed with the management of that hospital and will be funded to that extent.
Faced with the responsibility of ensuring that the massive financial resource of £37 million capital cost and approximately £2.5 million so far of equipment which has been put into the construction and fitting out of Beaumont Hospital is utilised without further delay and without further obstruction, I was reluctantly obliged to take these decisions in the light of the protracted but unsuccessful negotiations which have taken place over the past number of months with the consultants concerned.
A substantial number of the consultant medical staff were in favour of changing over but it is the old story of vested interests ruling the roost. I regret that the staff have refused to co-operate with the very reasonable arrangements which have been made to ensure the opening of this hospital. I assure my colleague, Deputy O'Hanlon, that I will not be resigning over this issue. I will be accounting to the electorate on the last Thursday in October 1987 or perhaps the second Thursday as it would be better if it was not too late into the winter, when presumably there will be a general election. The hospital will be open by then.
I have offered the consultants 70 beds in the hospital which has been built and additional beds for acute specialities where these might be required, for example, intensive care, dialysis and so on. There will be a sufficient number of private beds to cover their private practice. As I have already stated there are 750 beds in the hospital.
The money from the beds will go into the hospital budget and no VHI money will go into the coffers of any private company. That is the critical division. It is a public hospital with private beds in it. One must cater for those who are over the income limit and entitled to avail of public or private bed facilities and private consultation. Many more people avail of that than is necessary but that is the position. I have offered to make that space available within the hospital but I assure Deputies that under no circumstances will I agree to give public land on a leased basis to any private company of medical consultants to establish within the campus of the hospital yet another framework of a hospital. I want to see an integrated service, public and private, within the one building.
Where they may want to have private consultations on an outpatient basis, such facilities will be made available within the hospital. I have offered that the totality of the two budgets of the hospitals and all that this entails and all the staff from the two hospitals will go to Beaumont and work there in a very large hospital which will replace the appallingly bad physical conditions in the Richmond and Jervis Street hospitals, conditions which are bad for the staff and particularly bad for the patients and the people of Dublin.
I know that for some reason or other my predecessor caved in when people wanted to lease a slice of land belonging to the taxpayer in order to build another private hospital. I have no objection to people building private hospitals but not on public land and not in the framework of a public hospital.
